MEDICARE: PALM BEACH OUTPATIENT SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1962175059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH OUTPATIENT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	504 N REO ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4612
Country	:	US
Telephone Number	:	813-549-2134
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JOSHUA HELMS
Credential	:
Telephone Number	:	813-549-2134

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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